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High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles.

Publication ,  Journal Article
Steward, RG; Zhang, CE; Shah, AA; Yeh, JS; Chen, C; Li, Y-J; Price, TM; Muasher, SJ
Published in: J Reprod Med
2015

OBJECTIVE: To investigate parameters predictive of pregnancy outcomes in high responders undergoing fresh, autologous, GnRH antagonist IVF/ICSI cycles using a GnRH agonist trigger. STUDY DESIGN: Retrospective cohort study of all patients deemed high-risk for ovarian hyperstimulation syndrome who underwent fresh, autologous IVF/ICSI using a GnRH agonist trigger at an academic fertility center from 2010-2012. RESULTS: A total of 71 first cycles were analyzed. Rates of clinical pregnancy, live birth (LB), and total (clinical plus biochemical) miscarriage (MC) were 52%, 38%, and 25%, respectively. Mean peak estradiol (E2) and the number of oocytes retrieved were 3,701 pg/mL and 15.2, respectively. Peak E2 was significantly higher in those cycles resulting in clinical MC (p = 0.003). After adjusting for age, basal follicle stimulating hormone, and the number of oocytes retrieved, elevated peak E2 remained associated with increased clinical MC (p = 0.029) and trended towards a relationship with higher total MC (p = 0.062). When peak E2 was treated as a binary variable based on the threshold value of > 5,000 pg/mL, peak E2 above this value was associated with a higher rate of clinical MC (OR = 16.14 with 95% CI 1.25-209.35, p = 0.033) and total MC (OR = 6.81 with 95% CI 1.12-41.54, p = 0.037), as well as a lower LB rate (OR = 0.095 with 95% CI 0.01-0.90, p = 0.041). CONCLUSION: Clinicians should recognize most IVF/ICSI patients triggered with a GnRH agonist as inherently in danger of excessively high serum E2 and avoid peak levels > 5,000 pg/mL in order to avoid higher MC and lower LB rates.

Duke Scholars

Published In

J Reprod Med

ISSN

0024-7758

Publication Date

2015

Volume

60

Issue

11-12

Start / End Page

463 / 470

Location

United States

Related Subject Headings

  • Sperm Injections, Intracytoplasmic
  • Retrospective Studies
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Live Birth
  • Humans
  • Gonadotropin-Releasing Hormone
  • Fertilization in Vitro
  • Female
  • Estradiol
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Steward, R. G., Zhang, C. E., Shah, A. A., Yeh, J. S., Chen, C., Li, Y.-J., … Muasher, S. J. (2015). High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles. J Reprod Med, 60(11–12), 463–470.
Steward, Ryan G., Cindy E. Zhang, Anish A. Shah, Jason S. Yeh, Chen Chen, Yi-Ju Li, Thomas M. Price, and Suheil J. Muasher. “High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles.J Reprod Med 60, no. 11–12 (2015): 463–70.
Steward RG, Zhang CE, Shah AA, Yeh JS, Chen C, Li Y-J, et al. High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles. J Reprod Med. 2015;60(11–12):463–70.
Steward RG, Zhang CE, Shah AA, Yeh JS, Chen C, Li Y-J, Price TM, Muasher SJ. High Peak Estradiol Predicts Higher Miscarriage and Lower Live Birth Rates in High Responders Triggered with a GnRH Agonist in IVF/ICSI Cycles. J Reprod Med. 2015;60(11–12):463–470.

Published In

J Reprod Med

ISSN

0024-7758

Publication Date

2015

Volume

60

Issue

11-12

Start / End Page

463 / 470

Location

United States

Related Subject Headings

  • Sperm Injections, Intracytoplasmic
  • Retrospective Studies
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Live Birth
  • Humans
  • Gonadotropin-Releasing Hormone
  • Fertilization in Vitro
  • Female
  • Estradiol